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Mixed Signals: Americans' Problems Getting Medical Care Decline ModestlyBetween 2007 and 2010 Despite Poor Economy

1 in 6 Americans Faced Problems Getting Needed Medical Care in 2010, down from 1 in 5 in 2007

News Release
Aug. 25, 2011

Alwyn Cassil (202) 264-3484 or

WASHINGTON , DC—Likely reflecting the severe economic downturn and subsequent decline in demand for health care, the proportion of Americans who reported going without or delaying needed care declined modestly between 2007 and 2010, according to a national study released today by the Center for Studying Health System Change (HSC) and funded by the Robert Wood Johnson Foundation (RWJF).

About 9 million fewer people had health insurance in 2010 compared with 2007, and logically such a large increase in the uninsured population would be accompanied by an increase in access problems. However, approximately 17 percent of the U.S. population in 2010—about one in six people—reported not getting or delaying needed medical in the previous 12 months, down from 20 percent—one in five—in 2007, the study found.

The decline in access problems was driven primarily by fewer problems for insured people, likely reflecting recession-related decreases in the demand for medical care and subsequent easing of health system capacity constraints, according to the study.

In 2010, about 19.7 million people reported going without needed care and about 32.3 million people reported delaying needed care, for a total of roughly 52 million people reporting access problems, according to findings from HSC’s 2010 Health Tracking Household Survey, a nationally representative survey with information on 17,000 people. Funded by RWJF, the survey for the first time included a cell phone sample to account for the growing number of households without a landline phone. Response rates were 45 percent for the landline sample and 29 percent for the cell phone sample, for a combined response rate of 35 percent.

“While overall access problems declined, the access gap between insured and uninsured people widened in 2010, especially for lower-income people and those with health problems” said Ellyn R. Boukus, M.A., HSC health research analyst, and coauthor of the study with HSC Senior Fellow Peter J. Cunningham, Ph.D.

Overall, in 2010, people with incomes below 200 percent of poverty—$44,100 for a family of four—were 3.1 times as likely to report an unmet need as those with incomes at or above 400 percent of poverty (9.3% vs. 3%). This imbalance has grown since 2007, when low-income people were only 2.2 times as likely as higher earners to forgo care. Within each income group, uninsured people were roughly three times as likely as insured people to report going without needed care.

People who reported fair or poor health also were more likely to report forgoing needed medical care in 2010 compared with those in good, very good or excellent health (16.9% vs. 4.6%), the study found. This is in part because sicker people tend to use more health care and, therefore, have more opportunities to encounter access barriers. Between 2007 and 2010, unmet needs declined 1.6 percentage points—from 6.2 percent to 4.6 percent—among the healthier group and remained steady for those in fair or poor health.

The 52 million people reporting access problems increasingly identified cost as an obstacle to needed care—75.2 percent cited cost as a barrier in 2010 compared with 69 percent in 2007. At the same time, fewer people encountered health system-related barriers, such as getting timely appointments with doctors, possibly reflecting freed-up health system capacity because of lower demand.

The study’s findings are detailed in a new HSC Tracking Report—Mixed Signals: Americans’ Access to Medical Care, 2007-2010—available online at Other key findings include:

  • The proportion of insured people reporting an unmet medical need declined by more than a quarter—from 6.2 percent to 4.5 percent—between 2007 and 2010. At the same time, the incidence of unmet need among the uninsured fell slightly from 17.5 percent to 16.6 percent, but the change was not statistically significant.
  • Uninsured people in poor or fair health faced the greatest problems getting needed care, with nearly one in three (30%) reporting they went without needed care in 2010.
  • After a decline in access in the middle of the decade, children’s access improved slightly between 2007 and 2010. In 2010, roughly 3 percent of children did not get needed medical care and another 2 percent delayed care, the latter estimate almost half that for 2007.
  • Uninsured people with access problems were much more likely to cite cost as a barrier compared to insured people—95.3 percent vs. 65.9 percent in 2010. But, cost concerns increased significantly among insured people who encountered access problems, rising to 65.9 percent in 2010 from 60.7 percent in 2007.
  • As cost concerns became more prominent over time, health system-related concerns diminished in importance among both insured and uninsured people with access problems. More than half of insured people reported a health system barrier in 2010, a drop of 11 percentage points from 2007. Approximately one-quarter of uninsured people encountered a system-related barrier in 2010, down 16.2 percentage points from 2007.
  • Among all people citing a health-system obstacle, the biggest declines were associated with the following reasons: inability to get an appointment soon enough (10.2 percentage point decrease); takes too long to get to the provider (6 percentage point decrease); inability to get to provider when the office was open (5.7 percentage point decrease); and inability to get through on the telephone (5.5 percentage point decrease).
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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.


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